https://doi.org/10.4081/monaldi.2023.2625
Paradoxical reaction in peripheral lymph node tuberculosis: a review of its prevalence, clinical characteristics, and possible treatment
Submitted: May 5, 2023
Accepted: September 27, 2023
Published: October 3, 2023
Accepted: September 27, 2023
Abstract Views: 1687
PDF: 125
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The paradoxical reaction (PR) is a transient worsening following tuberculosis treatment, and it is not uncommon in lymph node tuberculosis (LNTB). PR in LNTB may be wrongly considered as treatment failure or relapse. This review was undertaken to address various aspects of PR associated with LNTB prevalence, underlying mechanisms, clinical patterns, predictors, and possible treatment in an immunocompetent individual. A literature review was performed using various databases (PubMed, Scopus, Science Direct, and Google Scholar) to identify relevant articles for review. The prevalence of PR associated with LNTB varies from as low as 13.3% to as high as 35.3%. PR may occur during antitubercular treatment or be reported even after completion of treatment, called post-therapy PR. An onset of PR may occur within a month of therapy to even 12 months from the initiation of an anti-tubercular drug. Delayed hypersensitivity reaction and reduction in immune suppression are believed to be possible mechanisms leading to a PR. PR in LNTB is characterized by either progression of pre-existing nodal enlargement or formation of abscess, sinus formation, or appearance of new nodal enlargement, or rarely extra-nodal involvement. PR is a diagnosis of exclusion and may show granuloma, positive acid-fast bacilli (AFB) smear, or positive GeneXpert, but AFB culture is always negative. Younger age, lymph node size of equal to or more than 3 cm, female gender, unilateral lymphadenopathy, and those with positive AFB on initial examination are predictors for PR in peripheral LNTB. The majority of PR in LNTB have a mild course and are generally self-limited.
Carvalho ACC, De Iaco G, Saleri N, et al. Paradoxical reaction during tuberculosis treatment in HIV-seronegative patients. Clin Infect Dis 2006;42:893-5.
Chen YM, Lee PY, Su WJ, Perng RP. Lymph node tuberculosis: 7-year experience in Veterans General Hospital, Taipei, Taiwan. Tuber Lung Dis 1992;73:368-71.
Cho OH, Park KH, Kim T, et al. Paradoxical responses in non-HIV-infected patients with peripheral lymph node tuberculosis. J Infect 2009;59:56-61.
Hawkey CR, Yap T, Pereira J, et al. Characterization and management of paradoxical upgrading reactions in HIV-uninfected patients with lymph node tuberculosis. Clin Infect Dis 2005;40:1368-71.
Park KH, Cho OH, Chong YP, et al. Post-therapy paradoxical response in immunocompetent patients with lymph node tuberculosis. J Infect 2010;61:430-4.
Batra S, Rajawat GS, Takhar RP, Gupta ML. Pattern and predictors of paradoxical response in patients with peripheral lymph node tuberculosis. Tuberk Toraks 2017;65:180-5.
Rajendra A, Sabnis K, Jeyaseelan V, Rupali P. Paradoxical reaction (PR) in tuberculous lymphadenitis among HIV-negative patients: retrospective cohort study. Postgrad Med J 2016;92:684-5.
Chahed H, Hachicha H, Berriche A, et al. Paradoxical reaction associated with cervical lymph node tuberculosis: predictive factors and therapeutic management. Int J Infect Dis 2017;54:4-7.
Rai DK, Kumar R, Ahmad S. Clinical characteristics and treatment outcome in tubercular lymphadenitis patients- A prospective observational study. Indian J Tuberc 2020;67:528-33.
Cheng VCC, Yam WC, Woo PCY, et al. Risk factors for development of paradoxical response during antituberculosis therapy in HIV-negative patients. Eur J Clin Microbiol Infect Dis 2003;22:597-602.
Choremis CB, Padiatellis C, Zou Mbou Lakis D, Yannakos D. Transitory exacerbation of fever and roentgenographic findings during treatment of tuberculosis in children. Am Rev Tuberc 1955;72:527-36.
Breen R, Smith C, Bettinson H, et al. Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection. Thorax 2004;59:704-7.
Belum GR, Belum VR, Chaitanya Arudra SK, Reddy BSN. The Jarisch-Herxheimer reaction: revisited. Travel Med Infect Dis 2013;11:231-7.
Campbell IA, Dyson AJ. Lymph node tuberculosis: a comparison of various methods of treatment. Tubercle 1977;58:171-9.
Cheng VCC, Ho PL, Lee RA, et al. Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. Eur J Clin Microbiol Infect Dis 2002;21:803-9.
Barr DA, Coussens AK, Irvine S, et al. Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy. Int J Tuberc Lung Dis 2017;21:677-83.
Wang CS, Chen HC, Yang CJ, et al. The impact of age on the demographic, clinical, radiographic characteristics and treatment outcomes of pulmonary tuberculosis patients in Taiwan. Infection 2008;36:335-40.
Cheng SL, Wang HC, Yang PC. Paradoxical response during anti-tuberculosis treatment in HIV-negative patients with pulmonary tuberculosis. Int J Tuberc Lung Dis 2007;11:1290-5.
Bhattacharya A, Mukherjee S. Paradoxical reaction in the form of pleural effusion after onset of anti-tuberculous medication for tubercular lymphadenitis. Clin Med 2017;17:143-5.
Thorve SM, Patil NS, Mandilwar S, Vora A. Loss of vision and hearing in a case of cervical lymph node tuberculosis: a rare paradoxical reaction. Lung India 2017;34:573-5.
Takahashi S, Otomo K, Kawakami Y, Nakamura M. Uveitis developing in tuberculous lymphadenitis-associated Behçet’s disease during anti-tuberculosis therapy. Respirol Case Rep 2020;8:e00617.
Lakshmi VP, Abhinandh B, Kunoor A, et al. Paradoxical reaction in lymph node tuberculosis presented as shoulder osteomyelitis. J Pharmacol Pharmacother 2021;12:140-3.
Brown CS, Smith CJ, Breen RAM, et al. Determinants of treatment-related paradoxical reactions during anti-tuberculosis therapy: a case control study. BMC Infect Dis 2016;16:479.
Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome. Medicine 2005;84:350-62.
World Health Organization Country Office for India. Index-TB guidelines: guidelines on extra-pulmonary tuberculosis in India. 2016. Available from: https://iris.who.int/handle/10665/278953
Bunkar ML, Agnihotri SP, Gupta PR, Arya S. Add-on prednisolone in the management of cervical lymph node tuberculosis. Indian J Tuberc 2016;63:96-9.
Geri G, Passeron A, Heym B, et al. Paradoxical reactions during treatment of tuberculosis with extrapulmonary manifestations in HIV-negative patients. Infection 2013;41:537-43.
Jung JW, Shin JW, Kim JY, et al. Risk factors for development of paradoxical response during anti-tuberculosis treatment in HIV-negative patients with pleural tuberculosis. Tohoku J Exp Med 2011;223:199-204.
Rakotoson JL, Rakotomizao JR, Andrianasolo RL, et al. Paradoxical lymphadenopathy during treatment of cavitary tuberculosis in an immunocompetent patient. Rev Pneumol Clin 2011;67:318-21. [Article in French].
Banani SA, Alborzi A. Needle aspiration for suppurative post-BCG adenitis. Arch Dis Child 1994;71:446-7.
Meybeck A, Just N, Nyunga M, et al. Needle aspiration in paradoxical hypertrophy of tuberculous lymphadenitis. Rev Mal Respir 2003;20:973-7. [Article in French].
Blackmore TK, Manning L, Taylor WJ, Wallis RS. Therapeutic use of infliximab in tuberculosis to control severe paradoxical reaction of the brain and lymph nodes. Clin Infect Dis 2008;47:e83-5.
How to Cite
Rai, Deependra Kumar, Surya Kant, and Vatsal Bhushan Gupta. 2023. “Paradoxical Reaction in Peripheral Lymph Node Tuberculosis: A Review of Its Prevalence, Clinical Characteristics, and Possible Treatment”. Monaldi Archives for Chest Disease 94 (3). https://doi.org/10.4081/monaldi.2023.2625.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Devika Tayal, Prabhpreet Sethi, Prerna Jain, Point-of-care test for tuberculosis: a boon in diagnosis , Monaldi Archives for Chest Disease: Vol. 94 No. 1 (2024)
- Claudio F. Donner, Laura Carrozzi, Sara Maio, Sandra Baldacci, Francesco Pistelli, Giovanni Viegi, Andrea Purro, Roberto Torchio, Enrico Clini, Sandro Amaducci, Richard L. ZuWallack, Roger Goldstein, Michael Morgan, Jean Bourbeau, Guido Vagheggini, Emiel F.M. Wouters, Integrating the care of the complex COPD patient , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- A. D'Andrilli, E.A. Rendina, F. Venuta, Tracheal surgery , Monaldi Archives for Chest Disease: Vol. 73 No. 3 (2010): Pulmonary series
- Gabriella Bettelli, Bruno Neuner, Postoperative delirium: A preventable complication in the elderly surgical patient , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
- Enrico Vizzardi, Edoardo Sciatti, Ivano Bonadei, Dario S. Cani, Elisa Menotti, Francesco Prati, Lucia Dallapellegrina, Marco Metra, Marialma Berlendis, Piercarlo Poli, Rita Padoan, Macro- and microvascular functions in cystic fibrosis adults without cardiovascular risk factors: A case-control study , Monaldi Archives for Chest Disease: Vol. 89 No. 2 (2019)
- Gian Francesco Mureddu, Current multivariate risk scores in patients undergoing non-cardiac surgery , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
- Francesca Cesari, Anna Maria Gori, Ilaria Romagnuolo, Rosanna Abbate, Endothelial progenitor cells and vascular health: effects of lifestyle’s modifications , Monaldi Archives for Chest Disease: Vol. 78 No. 2 (2012): Cardiac series
- Taymmia Ejaz, Mahmood Iqbal Malik, Jamal Ahmed, Rizwan Azam, Yousaf Jamal, Sheema Saadia, Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan , Monaldi Archives for Chest Disease: Vol. 92 No. 3 (2022)
- Paolo Ruggeri, Federica Lo Bello, Francesco Nucera, Michele Gaeta, Francesco Monaco, Gaetano Caramori, Giuseppe Girbino, Hereditary hyperhomocysteinemia associated with nephrotic syndrome complicated by artery thrombosis and chronic thromboembolic pulmonary hypertension: A case report , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Vinnie Sarah Ch Sangma, Surabhi Jaggi, Varinder Saini, Deepak Aggarwal, Pankaj Kumar, Jagdish Chander, Prevalence of latent tuberculosis infection in household contacts of pulmonary tuberculosis, time to treat , Monaldi Archives for Chest Disease: Vol. 94 No. 1 (2024)
<< < 2 3 4 5 6 7 8 9 10 11 > >>
You may also start an advanced similarity search for this article.
